Interobserver Reproducibility of Pelvicalyceal Invasion in Renal Cell Carcinoma Nephrectomies Among Genitourinary Pathologists

Authors

• Ankur R. Sangoi, Stanford Medical Center, Stanford.
• Mahmut Akgul, Brigham and Women's Hospital, Boston, MA.
• Aysha Mubeen, University of New Mexico, Albuquerque, NM.
• Robert Humble, University of Michigan, Ann Arbor, MI.
• Douglas Jian-Xian Wu, Stanford Medical Center, Stanford.
• Richard Pacheco, Albany Medical Center, Albany.
• Andres Acosta, Indiana University, Indianapolis, IN.
• Mahul Amin, University of Tennessee, Knoxville, TN.
• Manju Aron, University of Southern California, Los Angeles, CA.
• Fadi Brimo, McGill University, Montreal, Quebec.
• Emily Chan, Stanford Medical Center, Stanford.
• Liang Cheng, Brown University Providence, RI.
• John Cheville, Mayo Clinic, Rochester, MN.
• Katrina Collins, Indiana University, Indianapolis, IN.
• Kristine Cornejo, Massachusetts General Hospital, Boston, MA.
• Jasreman Dhillon, H. Lee Moffitt Cancer Center, Tampa, FL.
• Michelle R. Downes, Sunnybrook Health Sciences Centre.
• Jonathan I. Epstein, IMP Pathology, Garden City.
• Michelle Hirsch, Brigham and Women's Hospital, Boston, MA.
• Payal Kapur, UT Southwestern Medical Center, Dallas, TX.
• Anandi Lobo, Kapoor Centre of Urology and Pathology, Raipur, India.
• Rohit Mehra, University of Michigan, Ann Arbor, MI.
• Sambit Mohanty, CORE Diagnostics, Gurgaon.
• George Netto, University of Pennsylvania, Philadelphia, PA.
• Adeboye O. Osunkoya, Emory University School of Medicine, Atlanta, GA.
• Gladell Paner, University of Chicago, Chicago, IL.
• Priya Rao, MD Anderson Cancer Center.
• Rola Saleeb, University of Toronto, Toronto, Ontario.
• Rajal B. Shah, UT Southwestern Medical Center, Dallas, TX.
• Steven Shen, Houston Methodist Hospital, Houston.
• Steven Smith, Virginia Commonwealth University, Richmond, VA.
• Satish Tickoo, Memorial Sloan Kettering Cancer Center, New York, NY.
• Maria Tretiakova, University of Washington, Seattle, WA.
• Kiril Trpkov, University of Calgary, Calgary, Alberta, Canada.
• Sara Wobker, University of North Carolina, Chapel Hill, NC.
• Pheroze Tamboli, Brigham and Women's Hospital, Boston, MA.
• Debra Zynger, The Ohio State University, Columbus.
• Sean R. Williamson, Cleveland Clinic, Cleveland, OH.

Document Type

Article

Publication Date

12-1-2025

Abstract

Pelvicalyceal invasion (PCI) is a relatively novel pT3a staging parameter for renal cell carcinoma (RCC) nephrectomies. While interobserver reproducibility staging studies of sinus/vascular invasion in RCC exist, a similar evaluation for PCI has not been performed. Moreover, in our experience, there is also diagnostic variability in how pathologists interpret PCI. Herein, we explore interobserver reproducibility among genitourinary (GU) pathologists. Twenty hematoxylin and eosin-stained digitized slides from RCCs (all grossly approaching the renal pelvis) were distributed to 31 GU pathologists to classify each as PCI or not PCI based on their respective clinical practices; slides with concomitant sinus/fat/vascular invasion were excluded. Slides were then evaluated for the following 4 morphologic features: tumor abutting renal pelvis, tumor pushing/indenting into the renal pelvis, polypoid configuration of tumor into the renal pelvis, and tumor eroding through renal pelvic urothelium. Interobserver reproducibility was assessed, and the morphologic features were correlated with PCI. Relationships between pathologists' interpretations, morphologic features, and PCI were evaluated using hierarchical clustering. Although the diagnosis of PCI was relatively uniform with a majority agreement (>67%) reached in 16/20 slides, overall interobserver reproducibility was only moderate (kappa=0.601). While all 4 morphologic features were sensitive for PCI, polypoid configuration of the tumor into the renal pelvis and the tumor eroding through the renal pelvic urothelium were most specific (90%, 100%, respectively). Although we show general consensus among genitourinary pathologists on PCI assessment, clarifying the diagnostic guidelines with specific criteria should be included in pathologic staging systems.

Recommended Citation

Sangoi AR, Akgul M, Mubeen A, Humble R, Wu DJ, Pacheco R, Acosta A, Amin M, Aron M, Brimo F, Chan E, Cheng L, Cheville J, Collins K, Cornejo K, Dhillon J, Downes MR, Epstein JI, Hirsch M, Kapur P, Lobo A, Mehra R, Mohanty S, Netto G, Osunkoya AO, Paner G, Rao P, Saleeb R, Shah RB, Shen S, Smith S, Tickoo S, Tretiakova M, Trpkov K, Wobker S, Tamboli P, Zynger D, Williamson SR. Interobserver Reproducibility of Pelvicalyceal Invasion in Renal Cell Carcinoma Nephrectomies Among Genitourinary Pathologists. Am J Surg Pathol. 2025 Dec 1;49(12):1307-1314. doi: 10.1097/PAS.0000000000002456. Epub 2025 Jul 25. PMID: 40734292.